Systematic review of prognostic factors predicting outcome in non‐surgically treated patients with sciatica

Verwoerd, Annemieke; Luijsterburg, Pim A J; Lin, Chung‐Wei Christine; Jacobs, Wilco C. H.; Koes, Bart W.; Verhagen, Arianne P.

doi:10.1002/j.1532-2149.2013.00301.x

Cited by 49 publications

(76 citation statements)

References 52 publications

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“…Understanding of the prognostic factors in LBP and their relative importance may allow to identify patients who are at a higher risk for developing chronic LBP. Identification of prognostic factors predicting recovery, persistent pain, and disability are important for better understanding of the clinical course, to inform patients and physicians and support therapeutic decision making [4]. A diverse range of prognostic factors (demographics, physical factors, and psychological factors) has been studied in relation to persistent LBP [5].…”

Section: Introductionmentioning

confidence: 99%

The added prognostic value of MRI findings for recovery in patients with low back pain in primary care: a 1-year follow-up cohort study

et al. 2016

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Purpose Information on the prognostic value of MRI findings in low back pain patients in primary care is lacking. The objective of this study is to investigate the added prognostic value of baseline MRI findings over known prognostic factors for recovery at 12-month followup in patients with low back pain referred to MRI by their general practitioner. Methods Patients referred by their general practitioner for MRI of the lumbar spine were recruited at the MRI Center. The questionnaires at baseline and at 3 and 12-months follow-up included potential clinical predictors from history taking and the outcome recovery. The MRI radiology reports were scored. Analysis was performed in 3 steps: derivation of a predictive model including characteristics of the patients and back pain only (history taking), including reported MRI findings only, and the addition of reported MRI findings to the characteristics of the patients and back pain. Results At 12-months follow-up 53 % of the patients reported recovery (n = 683). Lower age, better attitude/beliefs regarding back pain, acute back pain, presence of neurological symptoms of the leg(s), and presence of non-continuous back pain were significantly associated with recovery at 12-months follow-up: area under the curve (AUC) 0.77. Addition of the MRI findings resulted in an AUC of 0.78. Conclusions At 12-months follow-up, only 53 % of these patients with low back pain referred for MRI in general practice reported recovery. Five clinic baseline characteristics were associated with recovery at 12-months followup; adding the MRI findings did not result in a stronger prediction of recovery.Keywords Low back pain Á Low back pain/diagnosis Á Magnetic resonance imaging Á Primary health care Á Outcome Á Predictive value of tests Á Area under curve Á Logistic models

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Section: Introductionmentioning

confidence: 99%

The added prognostic value of MRI findings for recovery in patients with low back pain in primary care: a 1-year follow-up cohort study

et al. 2016

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“…In terms of health care resource use, previous studies suggest that patients with radiating leg pain are more likely to undergo investigations and surgery than those with LBP only [7,12]. Our study suggests that within a population of primary care consulters, the presence of radiating leg pain is associated with more consultations with both primary and secondary care practitioners.…”

Section: Discussionmentioning

confidence: 53%

“…Although the majority of LBP patients improve within the first 6 weeks, those with radiating leg pain have higher levels of pain and disability [4], take longer to recover [3,5], are more likely to develop chronic symptoms [6] and also more likely to undergo surgery for their symptoms [7].…”

Section: Introductionmentioning

confidence: 99%

“…Although several systematic reviews have explored the prognosis of non-specific LBP [8][9][10] and sciatica [7], one of the major issues with considering leg pain as a prognostic factor is in the definition of leg pain and/or sciatica. Indeed, in a review by Kent and Keating [8], the authors highlight that some studies fail to provide a definition of 'sciatica' and, often, the term is used to describe any LBPrelated leg pain.…”

Section: Introductionmentioning

confidence: 99%

“…In a review by Hayden and colleagues [9], sciatica (or ''nerve root examination findings'') was considered to be a poor prognostic factor for low back pain, and similar findings were reported by Chou and Shekelle [10] with respect to presence of radiculopathy or leg pain. In a systematic review of prognostic factors predicting outcome in non-surgically treated sciatica patients, Verwoerd and colleagues [7] concluded that leg pain intensity at baseline was the only factor with a strong positive association with outcome.…”

Section: Introductionmentioning

confidence: 99%

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Pain location matters: the impact of leg pain on health care use, work disability and quality of life in patients with low back pain

et al. 2014

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Purpose In low back pain (LBP) patients, those with radiating leg pain or sciatica have poorer pain and disability outcomes. Few studies have assessed the effect of leg pain on health care use and quality of life. Methods Prospective cohort study of 1,581 UK LBP primary care consulters. Back pain, employment, health care utilisation, and quality of life (EQ-5D) data were collected at baseline, 6 and 12 months. At baseline, patients were classified as reporting (1) LBP only, (2) LBP and leg pain above the knee only (LBP ? AK) or (3) LBP and leg pain extending below the knee (LBP ? BK). Results Self-reported leg pain was common; at baseline 645 (41 %) reported LBP only, 392 (25 %) reported LBP ? AK and 544 (34 %) reported LBP ? BK. Patients with LBP ? BK, compared to those with LBP only, were significantly more likely to be unemployed, take time off work, consult their family doctor, receive physical therapy, or be referred to other health care practitioners. There were statistically significant decrements in EQ-5D scores for LBP ? AK compared to LBP only, and for LBP ? BK compared to LBP ? AK (p B 0.05 for all comparisons).Conclusions Patients with self-reported leg pain below the knee utilise more health care are more likely to be unemployed and have poorer quality of life than those with LBP only 12 months following primary care consultation. The presence of leg pain warrants early identification in primary care to explore if targeted interventions can reduce the impact and consequences of leg pain.

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New insight to the characteristics and clinical course of clusters of patients with imaging confirmed disc‐related sciatica

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Haugen

et al. 2019

European Journal of Pain

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Background Referral to secondary care is common for a considerable proportion of patients with persistent sciatica symptoms. It is unclear if information from clinical assessment can further identify distinct subgroups of disc‐related sciatica, with perhaps different clinical courses. Aims This study aims to identify and describe clusters of imaging confirmed disc‐related sciatica patients using latent class analysis, and compare their clinical course. Methods The study population were 466 patients with disc‐related sciatica. Variables from clinical assessment were included in the analysis. Characteristics of the identified clusters were described and their clinical course over 2 years was compared. Results A four‐cluster solution was optimal. Cluster 1 (n = 110) had mild back and leg pain; cluster 2 (n = 59) had moderate back and leg pain; cluster 3 (n = 158) had mild back pain and severe leg pain; cluster 4 (n = 139) had severe back and leg pain. Patients in cluster 4 had the most severe profile in terms of disability, distress and comorbidity and the lowest reported global change and the smallest proportion of patients with a successful outcome at 2 years. Of the 135 patients who underwent surgery, 42% and 41% were in clusters 3 and 4, respectively. Conclusions Using a strict diagnosis of sciatica, this work identified four clusters of patients primarily differentiated by back and leg pain severity. Patients with severe back and leg pain had the most severe profile at baseline and follow‐up irrespective of intervention. This simple classification system may be useful when considering prognosis and management with sciatica patients. Significance Using data from a large observational prospective study, this work identifies four distinct clusters of patients with imaging confirmed disc‐related sciatica. This classification could be used when considering prognosis and management with sciatica patients at their initial consultation.

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Systematic review of prognostic factors predicting outcome in non‐surgically treated patients with sciatica

Cited by 49 publications

References 52 publications

The added prognostic value of MRI findings for recovery in patients with low back pain in primary care: a 1-year follow-up cohort study

The added prognostic value of MRI findings for recovery in patients with low back pain in primary care: a 1-year follow-up cohort study

Pain location matters: the impact of leg pain on health care use, work disability and quality of life in patients with low back pain

New insight to the characteristics and clinical course of clusters of patients with imaging confirmed disc‐related sciatica

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